2008年桂林市麻疹流行分析

目的了解桂林市麻疹发病情况,为控制麻疹制定科学依据。方法采用描述流行病学方法统计分析。结果 2008年全市报告麻疹病例192例,报告发病率3.87/10万,<8月龄51例,占总病例数的26.6%,>15岁病例51例,占26.6%,散居儿童发病125例,占65.1%;病例以市区为主,占病例数的52.6%,主要集中在流动人口较多的城乡结合部;病例中未免疫的128例,免疫史不祥的52例,分别占总病例数的66.7%、27.1%。结论桂林市麻疹发病以小年龄婴儿和成人为主,要控制麻疹,在做好常规免疫工作的同时,必须加强流动人口的管理,提高流动儿童的接种率。     

2002—2012年云南省巍山县麻疹发病情况分析

目的了解云南省巍山县麻疹流行病学特征现状,为预防和控制麻疹提供参考依据。方法收集2002—2012年巍山县麻疹发病资料和麻疹疫苗接种资料,应用描述性流行病学方法进行统计分析。结果2002—2012年麻疹发病共68例,无死亡病例,年平均发病率2．01／10万;2005—2008年出现6起暴发痰睛;2009年后发病大幅度下降。年发病高峰期为1—3月;15岁以下儿童发病50例（73．52％）,7岁以下的儿童发病28例（41．12％）;散居儿童24例（35．29％）,学生28例（41．76％）,农民12例（17．65％）;仅28例有麻疹疫苗免疫史,无免疫史18例,免疫史不详22例。结论巍山县麻疹流行情况存在波动且伴随暴发,应该重点提高易感人群的麻疹疫苗接种率。     

Rubella immunity and morbidity: effects of vaccination in Finland

The occurrence of rubella antibodies and frequency of virologically proven rubella infections in different age groups were analyzed in a large serum material (about 60,000 sera) collected both before and after the start of nationwide vaccination of children against measles, mumps and rubella in Finland in 1982. The combined live vaccine significantly raised the rubella immunity of children and shifted rubella infections to older ages. In 1986, 91-98% immunity was found in the 2-10-year-old children so far covered by the vaccination programme; no rubella cases were diagnosed in this age group. We also demonstrated that another rubella vaccine given to about 60% of 13-year-old girls since 1975 both raised the immunity and reduced the occurrence of rubella in the vaccinated population. It is concluded that the rubella vaccinations, especially the combined vaccine given to small children, are effective, although the total number of reported rubella cases in the whole population did not decrease significantly during the study period.     

The largest outbreak of measles in the United States during 1999: imported measles and pockets of susceptibility

The largest measles outbreak in the United States during 1999 was traced to a 34-year-old minister with an undocumented history of vaccination, infected while traveling outside the United States. Local health departments in the Central Virginia Health District performed an epidemiological and laboratory investigation that identified 14 additional confirmed cases of measles, including 2 in health care providers and 5 in congregation members. Eight cases (53%) occurred among adults aged 30-35 years and 7 (47%) among children aged 13 months to 8 years. Although no religious exemptions were cited, only 2 case patients had documented proof of vaccination. This outbreak demonstrates the potential for limited indigenous spread of measles that occurs when imported cases expose susceptible groups. Almost half of the imported measles cases in the United States occur in US residents returning from foreign travel. Vaccination is highly recommended for all overseas travelers who are without documented proof of adequate immunization or measles immunity.     

Impact of the meningococcal C conjugate vaccine in Spain: an epidemiological and microbiological decision

The new meningococcal C conjugate vaccine became available in Spain and was included in the infant vaccination schedule in 2000. A catch-up campaign was carried out in children under six years of age. As a consequence, the incidence of meningococcal disease caused by serogroup C has fallen sharply during the last three epidemiological years in Spain. The risk of contracting serogroup C disease in 2002/2003 fell by 58% when compared with the season before the conjugate vaccine was introduced. There was also an important decrease in mortality. Three deaths due to serogroup C occurred in the age groups targeted for vaccination in 2002/2003, compared with 30 deaths in the same age groups in the season before the launch of the vaccine campaign. In the catch-up campaign the vaccine coverage reached values above 92%. For the 2001, 2002 and 2003 routine childhood immunisation programme coverage values ranged from 90% to 95%. During the past three years a total of 111 cases of serogroup C disease have been reported in patients in the vaccine target group. Most of the vaccination failures occurred during the epidemiological year 2002/2003. Eight (53%) vaccine failures occurred in children who had been routinely immunised in infancy, and could be related to a lost of protection with time since vaccination. The isolation of several B:2a:P1.5 strains (ST-11 lineage) is noteworthy. These may have their origin in C:2a:P1.5 strains which, after undergoing genetic recombination at the capsular operon level, express serogroup B. These strains could have relevant epidemic potential.     

A 24-year review on the epidemiology and control of measles in Singapore, 1981-2004

The objective of our paper is to review the epidemiology of measles in Singapore and the impact of the measles vaccination program on the control of measles. Our review will form the basis for a critical appraisal of our future measles control program. We analyzed the trend of reported measles cases in relationship to measles vaccination coverage from 1981 to 2004 using routine measles notifications and measles vaccination data submitted to the Ministry of Health and the National Immunization Registry, respectively. We determined the measles vaccine efficacy using data from epidemiological investigations of reported institutional measles outbreaks. The herd immunity of the population against measles was accessed through three seroepidemiological surveys that we conducted in 1989/1990, 1993 and 1998. In addition, we collected blood specimens from every clinically diagnosed case of measles notified to the Ministry in 1998/1999 to for measles-specific IgM antibodies in order to evaluate the proportion of clinically diagnosed cases of measles that were laboratory confirmed. The incidence of measles has decreased significantly since 1981 as a result of increased vaccination coverage of 89-93% following implementation of compulsory measles vaccination in 1985. However, resurgences still occurred in 1992/1993 and 1997. With the implementation of the two-dose measles vaccination schedule, the annual number of laboratory confirmed cases of measles to date has been less than 150. Vaccine efficacy of the trivalent MMR vaccine based on institutional outbreak investigations was consistently above 92%. We also found that the overall seroprevalence of the population to measles has decreased from approximately 91.5% in 1989/1990 to 1993 to 77.9% in 1998 (mainly in children < 4 years old) and that only 7% of clinically notified cases of measles were serologically confirmed to be positive for measles. Achieving a vaccination coverage of more than 95%, tightening our MMR vaccine delivery system and strengthening surveillance of measles are essential components which must be addressed in order to interrupt measles transmission in Singapore.     

Measles outbreak after a post-honeymoon period in Mongolia, 2001

In spite of the routine 2-dose vaccination and three recent supplemental immunizations, Mongolia experienced a measles outbreak in 2001, the largest epidemic in the country since 1984. The majority of cases were reported in the capital city, and the disease incidence was higher in infants and adolescents than in other age groups. Young adults who received the immunization only once may have low immunity, and may be exposed to the virus most frequently. Immunization strategies such as the age range that is targeted for vaccination and the interval between supplemental immunizations should be based on reasonable epidemiological observations.     

杨浦区水痘疫情特征分析及病例疫苗接种史调查

目的 掌握杨浦区水痘疫情特征,用发病资料评价疫苗流行病学免疫效果.方法 对2003-2005年发病资料进行描述分析,同时对所有病例进行疫苗接种史回顾性调查.结果 3年平均年发病率21.13/10万,暴发疫情中小学生占96.91%;发病时间和地区分布有集中趋势,年龄分布5～14岁组,占66.33%,94.75%病例无疫苗接种史.结论 水痘疫情呈上升趋势,0～4岁幼年组和年龄较大的在校学生均是水痘易感人群,疫情常在中小学校和幼托机构集体性单位频繁发生;病例疫苗接种率低.提高接种率是控制水痘发病的有效手段,当前应扩大疫苗接种年龄范围.     

A high school measles outbreak--control measures and vaccine efficacy

Epidemiological investigation of a March 2007 detected measles outbreak of 28 cases in a 792-student high school in Tokyo. Students with a vaccination history had significantly milder symptoms than those without, and no cases occurred among students having two of measles vaccine in two doses of measles vaccine in their childhood. Vaccine efficacy (VE) calculated in our investigation was 93.9% (95% CI:87-97), and no significant difference was observed in vaccine type or manufacturer product. Students and parents were extremely difficult to persuade to cooperate in control measures such as emergency vaccination and home isolation through notification letters even during outbreaks. Schools should thus develop measles outbreak preparedness and response plans and identify potentially susceptible students in advance through documented proof of case histories and MCV vaccination. Outbreaks should promote early detection of patients and emergency vaccination targetting potentially susceptible students backed through close cooperation with medical facilities, education institutions, and the public health sector, together with school closures as appropriate.     

Short report: assessing field vaccine efficacy for measles in famine-affected rural Ethiopia

Measles is a major cause of mortality in complex emergencies. Both high vaccination coverage and vaccine efficacy are required to prevent major epidemics of measles in such situations. Evaluation of field vaccine efficacy is a critical but underutilized component of program monitoring in emergencies, and is particularly important in rural areas where the integrity of the cold chain is difficult to guarantee. In July 2000, we evaluated the field vaccine efficacy for measles vaccination by comparing the incidence of cases in vaccinated and unvaccinated groups during a two-stage cluster survey of 563 children in Ethiopia. Approximately 30% of the measles cases occurred in vaccinated children. Estimated field vaccine efficacy for measles was 66.9% in children 9-36 months old. The finding of a field vaccine efficacy for measles less than 80% warrants formal assessment of measles vaccine efficacy, particularly in famine emergencies where measles is associated with a high case fatality rate.     

An outbreak of measles in Tanzanian refugee camps

From March 2000 to May 2001, four camps in Kibondo District, Tanzania, hosting refugees from Burundi reported 1062 cases of measles, a highly infectious and potentially lethal disease. Of 1062 case-patients, 225 (21%) were <9 months old, 286 (27%) were 9 months to 5 years, 324 (31%) were 6-15 years, and 227 (21%) were >/=16 years old. No deaths were reported. Although, in accordance with Sphere Project guidelines for humanitarian emergencies, camp policy was to vaccinate all new arrivals aged 6 months to 15 years against measles, 152 (72%) of 210 newly arrived refugees in this age group were unvaccinated; 143 (94%) of the 152 had lived in the camp >/=1 month before rash onset. This investigation supports Sphere Project recommendations for wide age group vaccination and suggests that in some circumstances vaccination of refugees >15 years old may be beneficial.     

新疆地区2007—2008年麻疹217例流行病学及临床特点分析

目的分析2007—2008年我科收治的217例麻疹病例流行病学和临床特点,为麻疹的诊治、预防和控制提供依据。方法对217例麻疹患者的发病年龄、发病时间、临床特点、并发症及诊治方面进行分析。结果 88.9%的患者发病时间为11月至次年3月。发病年龄有2个高峰,1岁以下(50.7%)和17～38岁(27.6%)。有明确麻疹接触史172例(79.3%),曾接种麻疹疫苗91例(41.9%)。发热201例(92.7%),体温以中等度热和高热多见;成人咳嗽剧烈;儿童卡他症状多见。48例(22.1%)临床经过呈不典型表现。实验室检查血象多正常或降低,心肌酶谱和肝酶增高多见。结论麻疹好发年龄前移或后移,不典型病例增多,婴幼儿并发症特别是心肌损害和肝损害多见。因此,对高危人群应加强免疫,并依据流行情况强化免疫。     

Evolution of the measles vaccination program in Costa Rica

The vaccination program instituted in Costa Rica in 1967 has had a great impact on measles. Since 1973 the downturn in its incidence and in mortality due to the disease are due solely to the continued vaccination of susceptible children throughout the country. An epidemic outbreak occurred in 1977. Since the vaccine was given primarily to children of school age, this outbreak probably was the result of an accumulation of susceptible subjects. There was little change in the mortality rates. Programs resulting in a coverage of 70% attempted to prevent a new outbreak in 1979, but failed. Because the vaccine was routinely administered to children one year of age and older, most of the cases were in the group younger than that age. At present, the incidence of measles is minimal, and no fatalities occurred in 1981. Vaccination coverage for children two years of age exceeds 90%, and Costa Rica's goal is the complete eradication of the disease.     

A review of the current impact of measles in the People's Republic of China

Before the vaccine era, epidemics of measles occurred in alternate years on the mainland of China. During epidemic years the annual incidence was as high as 1,000-5,000 cases/100,000 population, with a fatality rate of 1% to 2%. In 1965, when highly attenuated measles vaccine was developed in China, a vaccination campaign was launched throughout the country. In its early years, the immunization program was not implemented simultaneously at all places, and outbreaks that continued to occur in some areas resulted in a moderate local incidence of measles despite a decline in the overall incidence. From the late 1970s on, stronger measures were taken by local health authorities with regard to measles vaccination. By 1980 the incidence had dropped further; in that year the number of reported cases was 570,037, with 3,862 deaths. Both morbidity and mortality related to measles dropped drastically after vaccination from levels in the prevaccine era, but measles still accounts for an appreciable proportion of all cases of infectious disease.     

Prevalence of measles susceptibility in hospital staff. Evidence to support expanding the recommendations of the Immunization Practices Advisory Committee.

BACKGROUND--In 1989 and 1990, measles reached epidemic proportions in the United States, including several areas of California. Children's Hospital Oakland (Calif), a major health care provider for children in a measles epidemic area of California, reported 131 cases between 1989 and 1991, the largest number ever reported by that institution. In February 1990, four cases of measles were reported among hospital staff. Continued risk of nosocomial infection prompted the development of a program to ensure that all hospital staff were adequately protected against measles. METHODS--All hospital employees who were unable to document proof of measles immunity were required to be serologically screened for measles antibody and to be vaccinated against measles if they were determined to be nonimmune. Serologic screening was performed in-house with a commercially available enzyme-linked immunosorbent assay measles antibody test. Dates of birth were recorded for all employees screened. Individuals with negative or repeatedly equivocal results were considered to be nonimmune and were vaccinated with trivalent measles-mumps-rubella vaccine. RESULTS--Between March and June 1990, 1694 staff were serologically tested for measles antibody. Eighty-nine (5.3%) of the employees were considered to have inadequate immunity. Forty (45%) of these susceptible individuals were born before 1957. CONCLUSIONS--We conclude that the recommendations of the Immunization Practices Advisory Committee should be expanded to include serologic screening or vaccination of hospital personnel who were born before 1957. Serologic screening of hospital staff may be a reasonable alternative to vaccination under certain circumstances.     

Measles epidemiology and elimination strategies in Turkey

In Turkey, 15,000-30,000 measles cases have been reported annually since the 1990s. Epidemics occur every 3-4 years, and >/=90% of cases are <15 years old. The high incidence is due to inadequate vaccination coverage (nationally 84% in 2001) and immunity provided by the first dose of vaccine administered at age 9 months. The second dose, which has been recommended for first grade students since 1998, has been insufficient to provide the herd immunity necessary to control measles. The Ministry of Health launched a comprehensive program for 2002-2010 targeting measles elimination. This plan calls for a national vaccination campaign among all children aged 9 months to 14 years and routine two-dose vaccination coverage will be increased to >/=95% or follow-up campaigns will be conducted in areas not achieving high coverage levels. Also, all military recruits in 2002-2009 will be vaccinated and case-based, laboratory supported surveillance will be initiated.     

Progress toward measles and rubella elimination in Egypt

Measles and rubella were common infectious diseases in Egypt during the prevaccine era. Monovalent measles vaccine was introduced in 1977, and measles vaccination coverage increased from <50% to >90% from 1980 to 1999; however, measles outbreaks continued to occur at 2- to 4-year intervals during this period. After the introduction of a second routine dose of measles vaccine as a combined measles-mumps-rubella (MMR) vaccine in 1999 and the implementation of measles immunization campaigns targeting 6- to 16-year-old children during 2000-2003, reported measles cases dramatically decreased by 2003. In 2002, Egypt established a goal to eliminate measles and rubella and to prevent congenital rubella syndrome (CRS) by 2010. Large-scale rubella and measles outbreaks in 2005-2007, however, led to a revision of the plan of action to achieve the 2010 goals. A nation-wide measles-rubella immunization campaign, targeting children, adolescents, and young adults 2-20 years old, was conducted in 2 phases during 2008-2009 and achieved coverage >95%. With the decrease to record low levels of cases of measles and rubella in 2009 and 2010, Egypt should achieve measles and rubella elimination in the near future, but high coverage(>95%) with 2 doses of measles-rubella vaccine needs to be maintained, measles-rubella surveillance strengthened, and CRS surveillance developed.     

2008年新疆维吾尔自治区实施麻疹疫苗后续强化免疫活动评价

目的探讨加速控制和消除麻疹的策略和措施。方法 2008年对新疆维吾尔自治区全区范围8月龄～6岁儿童实施了麻疹疫苗（MV）后续免疫活动;利用新疆维吾尔自治区统计局资料、疫苗分发数、疫情资料等,对报告接种情况进行了评价。结果全疆麻疹强化免疫应种儿童1641861人,实际免疫儿童1616117人,接种率为98.99%,以县为单位报告接种率95%以上。结论开展MV初始强化免疫和后续强化免疫对控制麻疹效果非常显著。     

Subacute sclerosing panencephalitis in a tertiary care centre in post measles vaccination era

This study was conducted to observe the impact of measles vaccination on the epidemiology of subacute sclerosing panencephalitis (SSPE) in the post measles vaccination era. This is a retrospective study from a tertiary care hospital, covering a ten year period starting a decade after the introduction of the national measles immunization programme in India. We analyzed 458 serologically confirmed SSPE cases. These patients had a high cerebrospinal fluid: serum anti-measles antibody ratio. The male to female ratio in the present study was 4.4:1. The mean age at onset of SSPE was 13.3 years, showing an increase in mean age at onset of SSPE. Clinical and other demographic details, available from 72 in-patients, are discussed in this report. Of these, a history of measles could be elicited in 34 cases. Mean latent period between measles infection and onset of SSPE was 7.8 years. Six patients gave a history of measles vaccination. A sizable percentage (15.5 %) of the patients was > or = 18 years old and considered to have adult onset SSPE. The incidence of SSPE continues to be high and this report highlights the need for further strengthening routine measles immunization coverage.